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FORTOFFICE USE: ----- ------- ----------- -----------------_---....... APPLICATION FOR SANITATION PERMIT Permit No. r._ 4 (Complefe•in Duplicate) 3 --- This Permit Ex i►es 1 Year From Date Issued Date Issued -- Application is hereby made to the San Joaquin Local Health District4for a permit to construct and install the work herein descrbed. This application is made in com�YN oun Or cep_Wp. 549. JOB ADDRESS AN LOCATI _{ - Ie == 4 --------------------------------- Owner's Name----- a -- -.-. -------- •-- -------- ----------- - ---------- Phone----------- ---------- ------7 S`C ------------------•------------------------------------•-------••-------------------- -- Contractor's Installation will serve: Residence Apartment House ] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- - Number of bedrooms -__ Number of baths-`__ Lot size ater Supply: Public system ❑ Community system ❑ Private Depth to Water Table -- -- - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam a Clay Loam ❑ Clay ❑ Adobe p Hardpan ❑ Y' Previous Application Made: (If yes,date--------------..... ) Nog Naw Construction: Yes ❑ Nod?] FHA/VA: Yes ❑ No [] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu6iic sewer is available within 200 feet.) Septic Tank: Distance from nearest - well--A®- . .. .-__--Distance from foundation-__--/_:4'-.---..Material.-�-t_S±.C_i2��.� __ XL No. of compartments-..-------�--`.-.._Size-� A1C:- -- L,/-Liquid depth-.---� ----- -- .-.Capacity/.��-v------- Disposal Field: Distance from neares ell_ 0 Distance from foundation---- ,r -b--'._.Distance to nearest lot line,-A*94—.a&b , 91 Number of lines------- -----------------------Length of each line-- --��.---------_------Width of #rench....A- Type of filter material-- �. � .-Depth of filter mater' al----I I.. ------.Total length-.---�-�a--1-------------- Seepage Pit: Distance to nearest well .............Distance from foundation-------------------.Distance to nearest lot line----------------- 171 Number of pits--- ------------------Lining material.------------------- Size: Diameter----------------- Depth-------------- ------------------ Cesspool: Distance from nearest weli -----------------Distance from foundation..__------------- Lining material---------- .---_-_. - ❑ Size: Diameter- ------- - ----------------Depth---- ---------- --------------------------- _.------Liquid Capacity- ----------gals. Privy: Distance from nearest wellr-1 ___ Distance from nearest build in - -------------- -- Distance to nearest lot line _.............. - Remodeling and/or repairing (describe):-.-_--- ---------------------------- -------------------------------•-------------------------•-----•--------------- -- ------------------------------------------------- I -------------------------------------------------------------- ----- --- ------- --- I hereby c I have pre red this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a rer ulati As of the San Joaquin Local Health District. I h (Signed)- !- !1 -------- - ---�----- ------------ - ----------------------------- ----------- ---------- --------._(Owner and/ ontractor By------- ---- ----------------- - Titie _ ----- -- -------- -------------- -- ----------- --- ----- - ----- ----------------- ( )---------- --------------- (Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_,. ' -.----- DATE_. -- - - - -.- --------- ------ REVIEWED BY --------------------- -------------- -------------------- ---------- ---------------------- DATEE------- ILDING PERMIT ISSUED------ ------ DATE ---------------------------------------------- Alterations and/or recommendations:------- --------------- .-_._..- ------------------- -- ------- ------------------------------------------- -I——.............. -------------- ----------- FINAL INSPECTION BY .. Date-- .. -- - ---- --- ---- - �-------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Strdet X205 West 9t -Street Stockton,California Lodi. California / Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press